Study: More Docs Limit Sales Rep Access

via Daily Advantage from PharmaLive.com

"A new study is reporting that in another setback to field sales groups, there's a clear trend that more physicians are requiring appointments from reps or limiting their access altogether. Between June and December 2008, the percentage of physicians who require appointments advanced from 31.4 percent to 38.5 percent. Also, the percentage of physicians who forbid sales-rep access altogether rose from 22.3 percent to 23.6 percent, the study says."

Over 75% of physicians still meet with sales representatives. Even though over 70% of prescriptions should be for generic medications nearly 100% of the samples and "comparative" drug information come from brand-name drug representatives. Physicians want and will use good information, but it must meet a few criteria:

• Trusted information: "fair & balanced" information focusing on total health care & societal costs; "what would I do for someone I loved who was living on a tight budget?"
  
• High utility: Their time is money, so send concise information targeted to their prescribing patterns; do not blast all information to everyone
• Peer comparisons: I was initially surprised when nearly all physicians to whom I sent information requested that I add a comparison to their specialty peers; it seems that these comparisons help ensure them that any changes in prescribing habits would be the right thing to do, it helps validate the information we provide

My question to you: who would be the most trusted source of comparative drug information?

Does Increased Drug Use Increase Medicare Efficiency?

Interesting post on Healthcare Economist referring to a post by Gary Becker on the The Becker-Posner blog. He makes an interesting argument that Medicare Part D will increase Medicare efficiency due to the following effects:

1. Increased government payment for drugs will increase innovation, particularly for drugs used in the elderly
2. Better drugs and better access can offset more expensive medical care (e.g., hospitalizations)
3. High fixed costs for R&D, but low marginal costs for production, means that the average cost of drugs will decrease

I have seen reports of increased R&D, but do not have the references handy. Can anyone help out here? I also think that most people accept that better drug use can more than offset other medical expenses. In addition to better access, this also should focus on better drug selection and efforts to reduce drug therapy problems (e.g., noncompliance).

I do not think that the low marginal costs of production will reduce the average cost of drugs. The marginal cost is already so low that the gains would be negligible compared to the overall price of the drug. The majority of recent reductions in drug trend can largely be attributed to increased patent expirations and resulting generic introductions.

FDA Proposes Giving Up On Policing Off-Label Drug Promotion

This NY Times article nicely summarizes the issues. Basically, the draft guidance merely recognizes what actually happens in the marketplace; drug companies promote unapproved uses and physicians prescribe the drugs "off-label."

Who can serve as the "trusted advisor" for the patient?

• Drug companies have a major conflict of interest
• Physicians get most of their information from the drug companies
• Pharmacists don't get paid to provide this advice
• PBMs likely haven't earned back enough trust
• Health plans may not look at long-term benefits or risks
• Friends can give some scary advice
• Some foreign governments and state universities provide nice information
• Internet searches, but only if they know where to look and how to interpret the info